TY - JOUR
T1 - Risk of positive margins and biochemical recurrence in relation to nerve-sparing radical prostatectomy
AU - Sofer, Mario
AU - Hamilton-Nelson, Kara L.
AU - Schlesselman, James J.
AU - Soloway, Mark S.
PY - 2002/4/1
Y1 - 2002/4/1
N2 - Purpose: To assess the effect of nerve-sparing (NS) radical retropubic prostatectomy (RRP) on surgical margins and biochemical recurrence. Patients and Methods: Location and incidence of positive surgical margins, recurrence, and time to recurrence were assessed in a consecutive series of 734 men who underwent RRP for localized prostate cancer from 1992 through February 2000. NS procedures were used in 33% (n = 240) of 734 patients studied. Results: Surgical margins were positive for 24% (n= 58) and 31% (n = 152) of NS and non-NS patients, respectively (P = .06). No significant difference between the groups was found in location of positive margins (P = .92). Prostate-specific antigen level greater than 10 ng/mL, extraprostatic extension, tumor volume more than 20%, capsular penetration, Gleason score ≥ 7, positive margins, and seminal vesicle invasion were associated with significantly increased risk of recurrence. However, NS patients were not at increased risk of recurrence compared with non-NS patients (hazard ratio, 0.96; 95% confidence interval, 0.53 to 1.72). The cumulative risk of recurrence within 3 and 5 years of surgery in NS patients was 9.7% and 14.4%, respectively, as compared with 17.1% and 21.1% for non-NS patients. Conclusion: In patients with localized prostate cancer, neither margin status nor biochemical-free survival within 5 years of surgery were altered by the nerve preservation technique. Given our experience, we recommend preservation of neurovascular bundles in these patients whenever the procedure is technically feasible.
AB - Purpose: To assess the effect of nerve-sparing (NS) radical retropubic prostatectomy (RRP) on surgical margins and biochemical recurrence. Patients and Methods: Location and incidence of positive surgical margins, recurrence, and time to recurrence were assessed in a consecutive series of 734 men who underwent RRP for localized prostate cancer from 1992 through February 2000. NS procedures were used in 33% (n = 240) of 734 patients studied. Results: Surgical margins were positive for 24% (n= 58) and 31% (n = 152) of NS and non-NS patients, respectively (P = .06). No significant difference between the groups was found in location of positive margins (P = .92). Prostate-specific antigen level greater than 10 ng/mL, extraprostatic extension, tumor volume more than 20%, capsular penetration, Gleason score ≥ 7, positive margins, and seminal vesicle invasion were associated with significantly increased risk of recurrence. However, NS patients were not at increased risk of recurrence compared with non-NS patients (hazard ratio, 0.96; 95% confidence interval, 0.53 to 1.72). The cumulative risk of recurrence within 3 and 5 years of surgery in NS patients was 9.7% and 14.4%, respectively, as compared with 17.1% and 21.1% for non-NS patients. Conclusion: In patients with localized prostate cancer, neither margin status nor biochemical-free survival within 5 years of surgery were altered by the nerve preservation technique. Given our experience, we recommend preservation of neurovascular bundles in these patients whenever the procedure is technically feasible.
UR - http://www.scopus.com/inward/record.url?scp=0036534304&partnerID=8YFLogxK
U2 - 10.1200/JCO.2002.07.069
DO - 10.1200/JCO.2002.07.069
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C2 - 11919244
AN - SCOPUS:0036534304
SN - 0732-183X
VL - 20
SP - 1853
EP - 1858
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 7
ER -